It is often difficult to tell which patients with acute abdominal pain will require surgery. We studied 79 patients with acute abdominal pain who were thought likely, though not unequivocally, to have abdominal problems requiring surgery. All underwent laparoscopy and only 27 subsequently required open laparotomies. The accuracy rate as determined by followup was 99%. The liberal use of laparoscopy for uncertain cases of appendicitis resulted in a negative appendectomy rate of only 2.2%. There were no deaths and no major complications.